Contraception ppt review pharm

Questions and Answers

What is the primary mechanism of action of estrogen in suppressing ovulation?

Inhibition of gonadotropin-releasing hormone (GnRH) (correct)

Stimulation of follicle-stimulating hormone (FSH)

Promotion of ovarian follicle development

Inhibition of luteinizing hormone (LH)

Which of the following side effects is NOT commonly associated with estrogen usage?

Hyperpigmentation

Bone loss (correct)

Breast tenderness

Migraine

Which of the following is true about high-dose estrogen pills?

They are classified as low-dose contraceptives.

They are generally safe and have no significant risks.

They contain 10 - 20 mcg of estrogen.

They are closely associated with adverse thromboembolic events. (correct)

Which progestin is noted for its antiandrogenic properties?

Drospirenone Signup and view all the answers

What is a common consequence of long-term exposure to cyclic or daily progestins?

Endometrial decidualization and atrophy Signup and view all the answers

Which antibiotic is known to interact significantly with estrogen?

Amoxicillin Signup and view all the answers

What does DMPA usage primarily lead to over time?

Bone loss Signup and view all the answers

What is the primary purpose of the placebo pills in combined oral contraceptives (COCPs)?

To allow a withdrawal bleed Signup and view all the answers

What is the recommended action if a person using a progestin implant is postpartum?

They can insert it immediately after delivery. Signup and view all the answers

What is the main mechanism of action of the Copper IUD?

Create a hostile environment for sperm and prevent fertilization. Signup and view all the answers

How long can the progestin injection remain effective?

12 weeks after the first injection. Signup and view all the answers

If a woman misses her dose of progestin-only pills by more than 3 hours for norethindrone, what is the recommended action?

She must use a backup method for at least 7 days. Signup and view all the answers

Which of the following statements about the vaginal ring is correct?

It can remain in place for 3 weeks without removal. Signup and view all the answers

What is a significant consideration for women with a BMI greater than 30 using hormonal contraceptives?

Decreased effectiveness and increased risk of blood clots. Signup and view all the answers

What is the effectiveness of Phexxi when used correctly?

86% efficacy. Signup and view all the answers

When is the optimal time to start using the progestin injection?

Within the first 7 days of menses. Signup and view all the answers

What is a potential side effect of the progestin implant?

Irregular bleeding patterns. Signup and view all the answers

What is the active ingredient in the most effective emergency contraception, ulipristal acetate?

Selectively modulates progesterone. Signup and view all the answers

Study Notes

Estrogen

Suppresses ovulation by inhibiting gonadotropin-releasing hormone (GnRH) from the hypothalamus.
Reduces luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels and disrupts mid-cycle LH surge.
Common side effects: Hyperpigmentation, nausea, bloating, leg cramps, hypertension, migraines, breast tenderness, weight gain, fibroid growth.
Significant drug interactions: Valproate, oxcarbazepine, carbamazepine, phenytoin, topiramate, barbiturates, and certain antibiotics (e.g., amoxicillin, rifampin).
Ethinyl estradiol is the primary synthetic estrogen in U.S. contraceptives.
Low-dose pills contain 10-20 mcg estrogen; mid-dose has 30-35 mcg; high-dose has 50 mcg or more, linked to increased thromboembolic risks.
Contraindications include undiagnosed vaginal bleeding, hypertension, and evidence of clotting disorders.

Progestins

Mechanism of action involves thinning the endometrium, making it less suitable for implantation.
Long-term use results in endometrial decidualization and atrophy, thickens cervical mucus to inhibit sperm penetration, and disrupts tubal motility.
Classified by androgenicity: Norgestrel and levonorgestrel are highly androgenic; norethindrone acetate and desogestrel are weakly androgenic; drospirenone is antiandrogenic.
Neuropsychiatric effects can include depression.
Androgenic effects: Acne, hirsutism, increased LDL, and insulin resistance.
Third-generation progestins have a higher incidence of deep vein thrombosis (DVT).
DMPA (Depot medroxyprogesterone acetate) may cause bone loss.

Combined Oral Contraceptives (COCPs)

Types vary based on estrogen and progestin dosages and variation during the pill pack.
Some packs contain a full seven days of placebo; others vary from four to two pills.
Patch method: A patch delivering 150 mcg norelgestromin and 35 mcg ethinyl estradiol is applied weekly for three weeks, then a week off. Less effective if BMI >200 lbs.
Vaginal ring delivers 120 mcg etonogestrel and 15 mcg EE; replaced every three weeks, with potential for increased vaginal discharge.

Progestin-Only Pills

Includes norethindrone acetate and drospirenone; must be taken daily.
If started in the first five days of the cycle, no backup contraception is needed; otherwise, backup is required.
Small windows for missed pills: 3 hours for norethindrone, 12 hours for drospirenone.
Ideal for women with contraindications for estrogen usage, during breastfeeding, and postpartum.

Progestin Injections

Depot medroxyprogesterone acetate (DMPA) given every 12 weeks; first injection within the first seven days of menses or postpartum.
Side effects: Irregular bleeding, weight gain, depression, headaches, breast tenderness, and bone loss.

Progestin Implants

Etonogestrel implant effective for three years with 99% efficacy; may be less effective in obese patients.
Back-up method required for seven days post-insertion; can cause irregular bleeding and weight gain.

Progestin Intrauterine Devices (IUD/IUS)

Devices like Mirena, Kyleena, Liletta, and Skyla deliver levonorgestrel over varying durations (3 to 8 years).
Training is required for insertion.

Non-Hormonal Contraception

Copper IUD effective for 10 years; not recommended for nulligravid or those with a history of STIs.
Phexxi is a vaginal pH modulator gel with 86% efficacy when used before intercourse.

Emergency Contraception

Levonorgestrel (Plan B) dosages: 1.5 mg single dose or 0.75 mg taken 12 hours apart.
Most effective within 72 hours after unprotected intercourse.
COCPs can also be used for emergency contraception with specific dosing.
Ulipristal acetate is a selective progesterone modulator with high efficacy.
Copper-T IUD can be used up to 120 hours post-intercourse.

Pregnancy Considerations

Low likelihood of pregnancy if ≤7 days after menstruation, consistent use of contraception, ≤7 days after abortion, or fully breastfeeding without menstruation.

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Description

This quiz covers the mechanism of action of estrogen, including its role in suppressing ovulation and its effects on hormones such as LH and FSH. Additionally, it addresses the common side effects and drug interactions related to estrogen use.